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3rd year dentistry > Special Care Dentistry > Flashcards

Special Care Dentistry Flashcards

1
Q

Define what an impairment is

A

impairment is concerned with abnormalities in the structure or functioning of the body or its parts. Any loss or abnormality of psychological, physiological or anatomical structure or function

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2
Q

Define what is meant by disability

A

disability is concerned with the performance of activities; a restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal

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3
Q

Define what is meant by handicap

A

handicap is concerned with the broader social and psychological consequences of living with impairment and disability. A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, social and cultural function) for the individual

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4
Q

What Acts are in place to protect people with a disability?

A

The Equality Act (2010) Disability Discrimination Act (2004)

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5
Q

From what discrimination does the Equality Act protect people?

A

Discrimination against; age, pregnancy or having a child, disability, race, religion/belief or lack of, sex, sexual orientation

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6
Q

In relation to the Equality Act, what are protected situations?

A

At work, in education, as a consumer, when using public services, when buying or renting property, as a member or guest of a private club

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7
Q

What is the aim of the Disability Discrimination Act?

A

to end the discrimination which many disabled people face. This act gives disabled people rights in the area of; employment, access to goods, facilities and services, buying or renting property

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8
Q

What is autism?

A
  • Life long developmental disability - Affects area of brain controlling language, social interaction and creative and abstract thinking -Affects how a person communicates with and relates to people and the world around them
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9
Q

What are some features of autism?

A

-Impaired communication, social interaction, social imagination -hyper/hyposensitivity - Love of routine - Special interests - Special talents - Learning disability - Association with epilepsy, tuberous sclerosis and fragile x - Diet

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10
Q

How should preventive advice and treatment be offered to patients with Autism?

A
  • Dietary advice - OHI (timing, method) -Unflavoured toothpaste (oranurse) -Extra fluoride if high caries rate or if providing treatment likely to be difficult ( 2 x yearly fluoride varnish. Daily fluoride mouthwash 0.05%F) -2,800/5,000 ppm fluoride toothpaste
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11
Q

What should be taken into consideration if a patient with autism requires GA/sedation?

A

-Avoid if possible. -Issues to consider; capacity to consent, use of pre-meds eg temazepam, midazolam. Clinical holding -Most dental treatment is possible but need to be confident that treatment will be successful and last -Other procedures can be done at the same time such as blood tests, ECG, podiatry

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12
Q

What is the adults with incapacity act?

A

-A framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate, -The act aims to protect people who lack capacity to make particular decisions, but also to support their involvement in making decisions about their own lives as far as they are able to do so

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13
Q

Define capacity

A

-The ability or power to; Receive impressions. Receive knowledge. Do or understand something

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14
Q

Define incapacity

A

-Incapable of; Acting. Making decisions. Communicating decisions. Understanding decisions. Retaining the memory of decisions

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15
Q

How can capacity be demonstrated?

A

-Understand in simple language what the treatment is, its purpose and nature and why it is being proposed. - Understand its principle benefits, risks and alternatives - Understand in broad terms what will be the consequences of not receiving the treatment proposes -Retain the information long enough to use it and weigh it in the balance in order to arrive at a decision

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16
Q

What are the five principles of the adults with incapacity act?

A

1) Benefit 2) Minimum necessary intervention 3) Take account the wishes of the adult 4) Consultation with relevant others 5) Encourage the adult

17
Q

Who is a power of attorney?

A
  • Granted by the adult while s/he still has capacity - Can be a family member or a trusted frient - Similar procedure to making a will - Certified by a lawyer or medical practitioner - Registered with the Public Guardian - Referred to as a proxy
18
Q

What is a welfare power of attorney?

A

-Powers only come into effect when the adult is incapable of decision making -Must take into account the adults wishes - Matters relating to health and personal welfare - Must be registered with the office of the public guardian

19
Q

What is continuing power of attorney?

A

Only covers financial affairs and property

20
Q

What is a guardianship order?

A
  • Court appointed - Requires two medical reports - Continuous management of welfare and financial matters - Powers to deal with property, finance and even marital affairs - Usually appointed for 3 years
21
Q

How can oral cancer present in appearance?

A
  • Ulceration - White patches, red patches, mixed patches - Texture - Firm/fluctuant - Rolled margins, induration (hardened)
22
Q

What are some oral manifestations of hamatological malignancy?

A

-Gingival swelling - Mucosal pallor - Spontaneous bleeding - Petechia (purple/red spots) - Oral ulceration - Infections that are recurrent or severe (viral, fungal, bacterial)

23
Q

What should be considered in an oral cancer dental pre-assessment?

A
  • Remove infectious dental foci before the start of cancer therapy -Prepare the patient for expected side effects of cancer therapy - Management of the side effects of cancer therapy short/long term - Establish good oral hygiene to meet the increased challenge - Restoration? - Plan for maintaining oral hygiene, providing preventive care, completing oral rehabilitation and follow up
24
Q

What are some oral affects of cancer treatment?

A

The mouth is a potential source of infection which can be life threatening in immunocompromised patients. A potential portal of entry - Mouth is often too sore to eat and clean during therapy - Xerostomia and risk of further dental disease -Provision of dental treatment difficult during chemotherapy - Effects of chemo on blood cells - High risk of complications

25
Q

What is the advice on extractions prior to cancer therapy?

A
  • Wherever possible, teeth should be removed no less than ten days prior to cancer therapy, ideally three weeks. - Use an atraumatic technique - Achieve primary closure - Every measure should be put in place to aid quick healing of sockets and surgical sites
26
Q

What is the advice on restorations prior to cancer treatment?

A
  • Where possible this should be with a definitive material - If timescale is limited, consider GI as a provisional - Teeth and restorations should be smoothed; rough teeth can be very painful during period of mucositis - Can result in ulceration; portal of entry for infections
27
Q

What is mucositis?

A
  • Acute inflammation of the mucosa -Onset; Radiotherapy 12-15 days after first dose of treatment. Chemotherapy 1 week after first dose of treatment
28
Q

What are some preventive measures that can be taken against mucositis?

A

-Improved OH reduces healing time -Ill fitting dentures/sharp restorations should be adjusted -Mucosal sheilds (if radiotherapy)

29
Q

How can mucositis be managed?

A

-Difflam spray (Benzydamine hydrochloride mw 0.15%) - 2% lidocaine mw prior to eating -Gelclair -Chlorhexidine - Ice chips for 30 mins prior to treatment

30
Q

What are the implications of xerostoma following cancer treatment?

A

-Saliva can become thick, acidic and viscous; loss of protective features of saliva. -Radiotherapy can last two years or greater following treatment. May be permanent -Chemotherapy; salivary flow tends to return within two months. -Saliva can be stimulated or saliva replacements used

31
Q

What are the features noticed in a patient with Parkinson’s?

A
  • Mask like face
  • Slow speech and difficulty swallowing
  • Impaired dexterity
  • Abnormal posture and difficulty walking – shuffling Gait
  • Memory problems
32
Q

What is the dental relevance of Parkinson’s disease?

A
  • Difficulty accepting treatment:
    — Tremor of the body at rest
    — Often facial remorse reduces on purposeful movement
    e.g. mouth opening
    — Lack of control of oral muscles
  • Dry mouth common due to anti-cholinergic effects of drug
    treatment (Benztropine)
  • Increased risk of drug interactions
33
Q

What are the signs that a patient is in pain that can’t communicate well?

A
  • General signs:
    — Fidgeting, pacing, repetitive motions, refusal to eat,
    crying and groaning, refusal to cooperate
  • Facial signs:
    — Frowning, grimacing, teeth clenching, biting and
    rubbing area that is sore
  • Behavioural signs:
    — Aggressive behaviour, depression, isolation, sleep
    disturbances and withdrawal
34
Q

What is the difference between a patient with Parkinson’s and a patient with
cerebral palsy with regards to tremors?

A
  • Parkinson’s typically presents with intention tremors and
    Parkinsonism tremor at rest:
    — Intention tremor is present when tremor amplitude
    increases during visually guided movements towards a
    target at the termination of movement
  • Ataxia Cerebral palsy typically presents with action intentional
    tremors which is especially apparent when carrying out precise
    movements.
35
Q

What are the types of dementia?

A
  • Alzheimer’s:

— Reduction in the size of the cortex, severe in

hippocampus

— Presence of Plaques which are deposits of protein

fragments of beta-amyloid that builds-up in the spaces

between the nerve cells and tangles which are twisted

fibres of tau protein build-ups inside cells

  • Vascular:

— Caused by reduced blood flow to the brain, which

damages and eventually kills the brain cells

  • Dementia with Lewy bodies:

— Deposits of an abnormal protein – Lewy bodies – inside

the brain cells

  • Frontotemporal:

— The frontal lobe has associated ubiquitous associated

clumps of protein linked with TDP-43 found on it.

  • Rarer forms:

— HIV – related genitive impairment

— Parkinson’s disease

— Corticobasal degeneration

— MS

— Niemann-pick disease

— Creutzfeldt-Jakob disease (CJD)

36
Q

What legislation protects dementia?

A
  • The human rights act 2000
  • Disability discrimination act 2005
  • The equality act 2010
  • The adults with incapacity act (Scotland)
  • The mental capacity act (England and Wales)
37
Q

Who is involved in the multi-disciplinary team care for patients with dementia?

A
  • GP
  • Dentist
  • Consultant neurologist
  • Dementia nurse
  • Macmillan nurse when in late stages
  • Physiotherapists
  • Careers
38
Q

What are the symptoms of early, middle and late stage dementia?

A
  • Early:

— Symptoms are often misattributed to stress,

bereavement or normal ageing which include:

i. Loss of short term memory
ii. Confusion, poor judgment, unwilling to make

decisions

iii. Anxiety, agitation or distress over perceived

changes

iv. Inability to manage everyday tasks
v. Communication problems – decline in ability or

interest in talking, reading and writing

  • Middle:

— Increased obvious symptoms:

i. More support required including reminders to

eat, wash, dress and use the toilet

ii. Increasingly forgetful and may fail to recognise

people

iii. Distress, agression, Anger, mode changes –

frustration

iv. Risk of wandering and getting lost
v. May behave inappropriately e.g. going out in

nightclothes

vi. May experience hallucinations, throw-back

memories

  • Late:

— Much more progressive symptoms:

i. Inability to recognise familiar objects,

surroundings or people

ii. Increasing physical frailty, may start to shuffle

or walk unsteadily

iii. Difficulty eating and sometimes swallowing,

weight loss associated incontinence and gradual

loss of speech

iv. Symptoms are progressive and irreversible

3rd year dentistry (16 decks)

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